11789 - Laserfiche WebLink

Home Browse Search

LALL 0 APPLICATION FOR SANITATION PERMIT Permit No. ...1.._. (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinancence . 549. J�7 JOBADDRESS AND LOCATION_ --Owner's Name-_---..._. f-_ _ ----------- - - --------- -------------- ------- ------- Phone- Address----------- --- �. ---••--------- ----- Contractor's Name------------ 6� '� - ------------------------------------------ Phone_ -/ - ----------------------------------------------- Installation will serve: Residence [Er"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms , �� I r __ Number of baths .-/-- Lot size -_- ----`--�=- ,lea----- ------------------- Wafer Supply: Public system ❑ Community system ❑ Private 9�4epth to Water Table loZ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [+Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [R-**'1FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well-_-4 _� Distance rom foundation__- r C77 - � ..f . „ ,.�-�'---- Mat�ial__�-- �--� ------------------ ___1No. of compartments_------ ----__---- Size__ F-x�- - ------Liquid depth- 4"Z2...-____-..Capacity---YaU • I � Disposal Field: Distance from nearest well---� ___ -'Distance from foundation-.3--de,-_-----Distance to nearest lot line__----_.._ Number of lines---------- ------- -- ----- Length of each line----Ano--J __.___-.Width of french---- & of filter material___ epth of filter material____--f-�-��--.-Total length-_---- -�___.__--_ � r � Distance to nearest well-4r" f m fo ndation.__ }� _ .____.Disjance to nearest lot line_.--�P7____ Number of pits..--./__-.----_-__Lining material___ �Q-r# .--Size: Diameter- ��_Jrli:_.Depth--- - ---- ---------- ---- Cesspool: Distance from to nearest well................_Distance from foundation___ -.-_-_-_---____ Lining material----__-_--_------_------,----- ❑ S,ze: Diameter -------- --------Depth----------------------------- Liquid Capacity ------------------------ gals. Privy: Distance from nearest well- ------.------------------------------- __Distance from nearest building ❑ Distance to nearest lot line-------------- Remodeling and/or repairing (describe);----------- ----- f --- 1 �� - - _I------------------------ ___ .... ... _I• ------- r - _.-_._. _. __ ___. _ � --------------- I _ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Slaws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- . . ------------------------------------------ ------ ner and/or Contractor) $Y= {Title) - --- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----- ---------- ---- - --- DATE .., r ---------------------- - - REVIEWED BY_ ------- - ------- ! DATE.__, ..----_ 1.- BUILDING PERMIT ISSUED --- ------ ` ` r` g_:)-------------- -- ------- ------ ------------ DATE--- - ------------------------Alterations ------------------ -and/or recommendations:-------------------�---------- - - ----- ----------------------------------- - --- ------- ---------- --- ----------- --------------- -- ------------ ------------T-------- ------------- - ---------- - --------- ---- ---------- -----------------I----------------------------------------------------------- ------------------------------ ----- - - ----------_--------- -------- ---------- --------- -------__------------------------------------------------------------------------------------------...-.--.-.---- ------- -------------------------- --------------------- --------- -------------- ---------- ---------------------- ------------ ----------------------------------I-------I-------------------------------------------------------------- -------- ------------------ --------- --------_----------------------------------------I—------- ------------- ---------------- FiNAL -- --------- -- FINAL INSPECTION BY:.- -- ----- - - --------------------- - - Date_.-------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS 9 —2M ,4cv'eed s-'59 F.F,Ca -